title: Predictors of survival in patients with malignant gastric outlet obstruction: a patient-oriented decision approach for palliative treatment.
abstract: BACKGROUND
  Gastrojejunostomy and stentplacement are the most commonly used treatments for malignant gastric outlet obstruction (GOO). The preference for either treatment largely depends on the expected survival. Our objective was to investigate predictors of survival in patients with malignant GOO and to develop a model that could aid in the decision for either gastrojejunostomy or stentplacement.
  
  
  METHODS
  Prognostic factors for survival were collected from a literature search and evaluated in our patient population, which included 95 retrospectively and 56 prospectively followed cases. All 151 patients were treated with gastrojejunostomy or stentplacement.
  
  
  RESULTS
  A higher WHO performance score was the only significant prognostic factor for survival in our multivariable analysis (HR 2.2 95%CI 1.7-2.9), whereas treatment for obstructive jaundice, gender, age, metastases, weight loss, level of obstruction and pancreatic cancer were not. A prognostic model that includes the WHO score was able to distinguish patients with a poor survival (WHO score 3-4, median survival: 31 days) from those with a relatively intermediate or good survival (WHO score 2, median survival: 69 and WHO score 0-1, median survival: 139 days, respectively).
  
  
  CONCLUSIONS
  Only the WHO score is a significant predictor of survival in patients with malignant GOO. A simple prognostic model is able to guide the palliative treatment decision for either gastrojejunostomy (WHO score 0-1) or stentplacement (WHO 3-4) in patients with malignant GOO.
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center Rotterdam, The Netherlands. s.m.jeurnink@students.uu.nl
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Jeurnink
authors.forename: Ewout W
authors.initials: EW
authors.lastname: Steyerberg
authors.forename: Frank P
authors.initials: FP
authors.lastname: Vleggaar
authors.forename: Casper H J
authors.initials: CH
authors.lastname: van Eijck
authors.forename: Jeanin E
authors.initials: JE
authors.lastname: van Hooft
authors.forename: Matthijs P
authors.initials: MP
authors.lastname: Schwartz
authors.forename: Ernst J
authors.initials: EJ
authors.lastname: Kuipers
authors.forename: Peter D
authors.initials: PD
authors.lastname: Siersema
mesh_terms: D003657:Decision Making; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000523:psychology*; D017219:Gastric Outlet Obstruction / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010166:Palliative Care / Q000523:psychology*; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000401:mortality / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D015607:Stents / Q000523:psychology*; D015996:Survival Rate / Q000639:trends